[an error occurred while processing this directive]|[an error occurred while processing this directive]
放疗显著改善T1~2N1M0期三阴乳腺癌改良根治术后的局部区域控制
吴涛, 王淑莲, 金晶, 刘跃平, 王维虎, 宋永文, 余子豪, 刘新帆, 张江鹄, 李晔雄,
100021 北京协和医学院中国医学科学院肿瘤医院放疗科
Improved locoregional control with conventional radiotherapy following modified radical mastectomy for patients with T1-2N1M0 triple-negative breast cancer
Wu Tao, Wang Shulian, Jin Jing, Liu Yueping, Wang Weihu, Song Yongwen, Yu Zihao, Liu Xinfan, Zhang Jianghu, Li Yexiong
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
Abstract:Objective To evaluate the role of conventional radiotherapy following modified radical mastectomy for women with T1-2N1M0 triple-negative breast cancer (TNBC). Methods From 1996 to 2010, 215 patients diagnosed with T1-2N1M0 TNBC were retrospectively analyzed. All patients were treated with modified radical mastectomy (MRM). Of them, 66 patients received postmastectomy conventional radiotherapy and 146 patients did not. Locoregional recurrence-free survival (LRRFS) and overall survival (OS) were compared between two groups with or without propensity-score matching methods. Results With a median follow-up of 56 months, 36 patients developed locoregional recurrence (LRR). The 5-year LRRFS and OS rates were 92.6% and 82.8% for MRM compared with 76.6%(P=0.010) and 84.7(P=0.499) for postmastectomy conventional radiotherapy, respectively. In multivariate analysis, MRM and T2 were associated with increased LRR. In matched-pair of radiotherapy and no radiotherapy using propensity-score matching methods, the 5-year LRRFS was 92.6% for MRM plus RT compared with 74.5% for MRM (P=0.008). Multivariate analysis indicated that no radiotherapy was the only independent prognosticfactor associated with increased LRR (HR=3.536,95%CI=1.153—10.844;P=0.027). Conclusions Patients with T1-2N1M0 TNBC treated with MRM without RT appear to be at an increased risk for LRR compared with those treated with MRM and RT. Prospective studies are warranted to investigate the benefit of postmastectomy conventional radiotherapy to improve the outcome of patients in T1-2N1M0 TNBC.
Wu Tao,Wang Shulian,Jin Jing et al. Improved locoregional control with conventional radiotherapy following modified radical mastectomy for patients with T1-2N1M0 triple-negative breast cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(2): 87-92.
[1] Taghian A, Jeong JH, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy:results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials[J]. J Clin Oncol,2004,22:4247-4254. [2] Katz A, Strom EA, Buchholz TA, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy:implications for postoperative irradiation[J]. J Clin Oncol,2000,18:2817-2827. [3] Recht A, Gray R, Davidson NE, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation:experience of the Eastern Cooperative Oncology Group[J]. J Clin Oncol,1999,17:1689-1700. [4] Lowery AJ, Kell MR, Glynn RW, et al. Locoregional recurrence after breast cancer surgery:a systematic review by receptor phenotype[J]. Breast Cancer Res Treat,2012,133:831-841. [5] Nguyen PL, Taghian AG, Katz MS, et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy[J]. J Clin Oncol,2008,26:2373-2378. [6] Wo JY, Taghian AG, Nguyen PL, et al. The association between biological subtype and isolated regional nodal failure after breast-conserving therapy[J]. Int J Radiat Oncol Biol Phys,2010,77:188-196. [7] Bauer KR, Brown M, Cress RD, et al. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype:a population-based study from the Californiacancer Registry[J]. Cancer,2007,109:1721-1728. [8] Voduc KD, Cheang MC, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse[J]. J Clin Oncol,2010,2:1684-1691. [9] Truong PT, Olivotto IA, Whelan TJ, et al. Clinical practice guidelines for the care and treatment of breast cancer:16. Locoregional post-mastectomy radiotherapy[J]. CMAJ,2004,170:1263-1273. [10] Taylor ME, Haffty BG, Rabinovitch R, et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast[J]. Int J Radiat Oncol Biol Phys,2009,73:997-1002. [11] Wang J, Shi M, Ling R, et al. Adjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma:a prospective randomized controlled multi-center trial[J]. Radiother Oncol,2011,100:200-204. [12] van der Hage JA, Putter H, Bonnema J, et al. Impact of locoregional treatment on the early-stage breast cancer patients:a retrospective analysis[J]. Eur J Cancer,2003,39:2192-2199. [13] Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial[J]. N Engl J Med,1997,337:949-955. [14] Overgaard M, Nielsen HM, Overgaard J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials[J]. Radiother Oncol,2007,82:247-253. [15] Buehholz TA,Woodward WA,Duan Z,et al.Radiation use and long term survival in breast cancer patients with T1,T2 primary tumors and one to three positive axillary lymph nodes[J].Int J Radiat Oncol Biol Phys,2008,71:1022-1027. [16] Rangan AM, Ahern V, Yip D, et al. Local recurrence after mastectomy and adjuvant CMF:implications for adjuvant radiation therapy[J]. Aust NZJ Surg,2000,70:649-655. [17] Smith BD, Smith GL, Haffty BG. Postmastectomy radiation and mortality in women with T1-2 node-positive breast cancer[J]. J Clin Oncol,2005,23:1409-1419. [18] Kyndi M, Srensen FB, Knudsen H, et al. Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer:the Danish Breast Cancer Cooperative Group[J]. J Clin Oncol,2008,26:1419-1426. [19] Freedman GM, Anderson PR, Li T, et al. Locoregional recurrence of triple-negative breast cancer after breast-conserving surgery and radiation[J]. Cancer,2009,115:946-951. [20] Haffty BG, Yang Q, Reiss M, et al. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer[J]. J Clin Oncol,2006,24:5652-5657. [21] Del Casar JM, Martín A, García C, et al. Characterization of breast cancer subtypes by quantitative assessment of biological parameters:relationship with clinicopathological characteristics, biological features and prognosis[J]. Eur J Obstet Gynecol Reprod Biol,2008,141:147-152. [22] Metzger-Filho O, Sun Z, Viale G, et al. Patterns of recurrence and outcome according to breast cancer subtypes in lymph node-negative disease:results from International Breast Cancer Study Group Trials Ⅷ and Ⅸ[J]. J Clin Oncol,2013,31:3083-3090.